This injury occurred on a combined U.S. and Australian special operations mission in the mountains of southern Afghanistan a few years back. The case study is one I used some photos from in my previous post, “Why I’d rather be shot by an AK-47 than an M4.” After that post, I had multiple emails requesting further information about this case study and how he was medically managed. So here it is.

The casualty in question was, in fact, an enemy combatant, which explains how he came to be shot with an M4 (another point that I received a few questions about from my previous post). During the firefight on that day, the casualty was hit by a single M4 round from a range of approximately 150 meters. The bullet entered through his right lower buttock and exited out his right upper thigh. Unbeknownst to the medic who initially reviewed the casualty at point of injury, the bullet had struck the casualty’s upper femur, disintegrating and shattering the bone, which in turn created multiple secondary missiles in the form of bone fragments.

As the enemy combatant was incapacitated by the wound, he was no longer considered a threat and therefore, in accordance with the Geneva Convention, was to be afforded the same medical care as one of our own. On initial review, the treating medic noted the massive lateral thigh wound to be bleeding significantly, but assessed the wound as being too high for effective arterial tourniquet placement. He therefore opted for the use of a hemostatic dressing, which in those days came in the form of a QuikClot advanced clotting sponge (ACS). For those of you who weren’t around in the days prior to QuikClot combat gauze, the ACS was a precursor dressing to the combat gauze, and consisted of a teabag-like structure filled with small granules of hemostatic dressing.

Quikclot ACSQuikclot ACS 2